A Centre of Excellence for Universal Health Coverage

Universal Health Coverage stipulates that “all people have access to essential health services without the financial hardship associated with payment” (Lancet 2010). The necessity of UHC have been emphasized in global forums again and again [e.g., WHA resolutions in 2008 and 2011, World Health Reports in 2008 (PHC: now more than ever) and 2010 (Health financing), Commission on Social Determinants of Health 2008, First World Social Security Report 2010 etc.)]. Also, countries like India, Vietnam, Thailand, Ghana, Rwanda are marching ahead to the road of UHC since the beginning of the 21^st century. As the movement for UHC intensifies in other parts of the world, there is an imperative to prepare Bangladesh for it!

Bangladesh is at a crossroad with respect to ensuring health coverage for its entire population, especially the poor and the marginalized, hard-to-reach population. This is especially important given the income-erosion effect of illness and the very regressive method of healthcare financing through out-of-pocket expenditure (OOP, which stands at 64% of the Total Health Expenditure in 2007) at point of use. This OOP has been found the most inefficient and inequitable way to finance health care…according to one estimate, about 4-5 million people in Bangladesh are driven into poverty annually by catastrophic health expenditure (expenditure on health exceeding 10% of total household expenditure or ≥25% of non-food expenditure), and responsible for 22% of all shocks in the lives of the poor. In many cases these direct payments prevent access; in others they impose severe financial stress on people using services. They encourage inefficiency and inequity in the way available resources are used, by encouraging over-servicing for people who can pay, accompanied by under-servicing for people who cannot. One way of correcting this is through Universal Health Coverage (UHC) for the population at large.

To accelerate evidence informed, equitable and sustainable action towards Universal Health Coverage (UHC) in Bangladesh and globally, a Centre of Excellence on Universal Health Coverage was jointly established by icddr,b (Centre for Equity and Health Systems) and James P. Grant School of Public Health (JPGSPH) at BRAC Institute of Global Health (BIGH), BRAC University in April 2011 with financial support from the Rockefeller Foundation (RF). The Centre is physically located at JPGSPH, BIGH premises. To achieve the above objectives, the center generates “essential evidence” through research, develops “core competencies” by training relevant workforce based on identified felt needs, and fosters learning through knowledge sharing by using a “UHC Forum” and bringing out reports from Bangladesh Health Watch on relevant issues.

The CoE-UHC is now passing its third year. Over the years, the Centre saw the development of initiatives in areas of its core mandate such as generating evidence (to guide the design of UHC policies and programs), developing competencies (for effective policy and practice) and providing forums to stakeholders disseminating and sharing knowledge and experiences on UHC issues). During this time, the Centre undertook research on HRH issues (e.g., current scenario, rural retention, MATS in private sector etc.), developed and implemented need-based short courses (on introduction to UHC, health care financing etc.) and organized Tanahashi Forum to identify bottlenecks to universal coverage of health interventions, and a UHC Forum to bring together academics, policy makers, development partners and civil society representatives to discuss UHC issues and curve a roadmap for moving forward. The visibility of the Centre increased through organizing different workshops, and round table dissemination sessions where policy makers and programme implementers also participated. The researchers from the Centre also participated in seminar and conferences related to UHC issues, including interaction with policy makers in the public sector. 

A recent informal review of the activities of the Centre emphasized the need to push the CoE-UHC agenda further forward, given the current global health scenario towards universal health coverage, and also national impetus to move the UHC agenda forward as envisaged in the recent Lancet Series on Bangladesh.  It was felt that the Centre needs to be more pro-active and align it with the bigger emerging Global Health agenda such as post-2015 development agenda, and curve out a position for itself. The big picture of how the CoE-UHC can do this was also discussed and a consensus reached to do a strategic planning exercise which will be held this year.

For more, pl visit http://www.coe-uhc.org